Background:
Australia has the highest prostate cancer screening rates in the world. But recent estimates show that more than 40% of prostate cancers identified through screening are overdiagnosed. These cancers would not have caused symptoms or problems during a man’s lifetime, yet they are detected and treated, often with major complications. Recommendations for doctors to offer decision support have been incorporated into national clinical practice guidelines for prostate screening. However, evidence shows that men are being screened for prostate cancer without their knowledge or consent alongside routine bloodwork. We present a protocol for a new approach – delayed screening - targeting problems of overdiagnosis and uninformed screening. The delay strategy is akin to delayed prescribing described in the literature, which has proven to be effective in reducing inappropriate antibiotic use. It is an exciting and innovative method yet to be applied in the cancer context.
Aims:
Methods:
Phase 1. Codesign and development: (a) Sequential focus groups with men (n=15-25) and GPs (n=15-25) to co-produce delayed screening intervention and generate implementation plan. (b) User acceptance testing and develop GP training webinar. Phase 2. Proof of concept: (a) Collect pre-intervention data capturing usual practice. (b) Implement intervention in Australian primary care practices over 2-month period (n=20 GPs, n=~10 patients per GP). Quantitative data collected via pre/post questionnaires and medical record audit. Post-intervention data will be compared to baseline. Qualitative process evaluation.
Outcomes may signpost a promising strategy to reduce uninformed screening, counteract patient expectations for low-value testing, reduce GP habitual ordering of tests, and thereby mitigate the harms of over-testing, overdiagnosis, and overtreatment. Findings will provide insights applicable to other similar, low-value health care contexts.